Provider Demographics
NPI:1689706905
Name:WAYNE FOOT SPECIALISTS PC
Entity Type:Organization
Organization Name:WAYNE FOOT SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:LIND
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-734-8007
Mailing Address - Street 1:207 LEE STREET
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3821
Mailing Address - Country:US
Mailing Address - Phone:919-734-8007
Mailing Address - Fax:919-736-4048
Practice Address - Street 1:207 LEE STREET
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3821
Practice Address - Country:US
Practice Address - Phone:919-734-8007
Practice Address - Fax:919-736-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC221213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08067OtherBLUE CROSS OF NC
NC8908067Medicaid
NC=========OtherTAX I D
NC=========OtherTRICARE
NC243127Medicare ID - Type Unspecified
NC8908067Medicaid
NC5894610001Medicare NSC
NC08067OtherBLUE CROSS OF NC